Mount Sinai’s Icahn School of Medicine (New York, NY) provides a model for adopting palliative care practices into their solid tumor oncology service that results in significant increases in hospice referrals and decreases in readmission rates and chemotherapy receipt postdischarge.
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Patients with cancer who have reached advanced stages and have a limited life expectancy often continue to receive aggressive therapies, which negatively affects quality of life without offering therapeutic benefits. Recent research has shown that palliative care practices, such as hospice services, may result in improved symptom burdens and end-of-life care, greater attainment of patient goals, reductions in depression, and lessened feelings of burden among surviving caregivers.
Mount Sinai’s Icahn School of Medicine has adopted palliative care practices for their oncology services to improve patient care and reduce wasteful medical expenditures. Journal of Clinical Pathway spoke with Kerin B Adelson, MD, formerly employed by Icahn School of Medicine, to obtain advice for oncologists and physicians to use to recognize which patients will benefit from palliative services versus continues aggressive treatment.
Dr Adelson asserted that palliative care principles have not been integrated into general practice in many oncology systems due to a lack of formal training in conducting goals of care conversations with oncologists, the orientation of most oncologists being to treat cancer and prolong life (even in the end-of-life setting), and the tendency for oncologists to move quickly into discussions about treatment rather than prognoses and goals with patients.
After helping to design and implement a study to assess palliative care services, Dr Adelson and colleagues found that palliative care consultations resulted in significant increases in hospice referrals, increased support system after discharge, and reduced both 30-day readmissions and chemotherapy receipt following discharge. Additionally, researchers found that a reduction in chemotherapy administration following discharge suggested that their intervention helped patients identify their goals and pursue care that focused on quality of life.
“Our study did not measure quality of life, but hospice referral has been show to improve quality of life. So if we are increasing hospice rates, it stands to reason that we are increasing quality of life as well,” said Dr Adelson.
In her concluding remarks, Dr Adelson expressed her belief that Mount Sinai’s palliative care practices are “absolutely” applicable across the spectrum, due to the criteria being easy to employ.
Click here to read the full interview. — Zachary Bessette
